In Hedwig and the Angry Inch, the titular character

undergoes M2F gender reassignment surgery in order to pass a mandatory physical exam prior to obtaining a license to wed their partner (a man).

Is there a historical basis for mandatory premarital exams?

  • 8
    I am not sure a comedy film is a notable claim and it is just a concept that someone thought funny just like the Adam Sandler movie "I Now Pronounce You Chuck & Larry"
    – Joe W
    Commented Jun 26, 2022 at 4:31
  • @Joe-W Well, I could ask this in Law or Movies&Film if one of those are more appropriate.
    – alexw
    Commented Jun 26, 2022 at 18:15
  • 1
    Unless you can show that this comedy was based off of history you can't use it as evidence that the events actually took place.
    – Joe W
    Commented Jun 27, 2022 at 0:56
  • 3
    Here is the meta-question discussing whether similar claims are notable. I haven't read this book, but it appears to count as a claim the writers would expect readers to believe to be true about the real world.
    – Oddthinking
    Commented Jun 27, 2022 at 2:10
  • 3
    I would prefer the title was a bit more specific, because physical exams before marriage to test for genetic incompatibilities, STIs and other conditions are not unknown.
    – Oddthinking
    Commented Jun 27, 2022 at 2:12

3 Answers 3


We don't need to go so back far in time: mandatory genital inspections (in the sense of, if you don't do it, you can't get legally married) arose in Victoria, Australia, prior to same-sex marriage legalization in Australia (in 2017). If you transitioned and wished to update your birth certificate, you needed to:

Attach either:

  • Statutory declarations from two separate medical practitioners verifying that you have had sex affirmation surgery, or
  • A current interstate recognition certificate issued by that state. The certificate must identify you as being of a particular sex.

Change your recorded sex, Births, Deaths, and Marriages (archived 2019)

So genital inspections were a requirement in Victoria for changing one's sex on their Victorian birth certificate (up to around 2020), which was a requirement for marriage. (Nowadays, you can change your sex descriptor to almost anything without surgery.)

Generally a surgeon performing the operation will provide a certificate. However, if you went overseas for the surgery, their documents were not considered acceptable: they had to have an Australian medical registration number.

By the looks of webpages like transhub, comparable legislation was in place in New South Wales, and doctors (at least the ones trans people would go to about such matters) tried to minimize the discomfort resulting from these genital inspections:

Some doctors will ask their patient to explain the details of the surgery that was undertaken and what was involved, minimising the need for a physical examination. Some doctors also talk with their patient about what is involved with a medical examination and other reasons it can be helpful, apart from legal gender affirmation. For example, doing a genital examination post-operatively to assess for complications or wound healing as part of post-surgical care.

In any case, GRS is major surgery, and to get it you'll go through a series of tests (physiological and psychological) over a long period of time (see the WPATH Standards of Care). If GRS is mandatory for something, then one way or another many physical exams are mandatory too.

Nevertheless, this is a comparatively rare scenario. Most people getting married in Australia did not have this step.

A totally separate instance of premarital medical checks is: prior to 2003, China used to have mandatory 婚前检查 (premarital checkups):

In China, couples hoping to marry must undergo a physical check before being granted a marriage certificate.

"The medical check is the sole criterion for finding whether the couple is healthy or otherwise. We only give licenses to couples who pass the check," said Zhou Jixiang of the Shanghai Civil Affairs Bureau which is in charge of issuing marriage certificates.
Premarital Test Revised, China.org.cn, 2002.

They'd check all sorts of things. Therese Hesketh published her experience and analysis in the British Medical Journal (2003):

My main memories of the examination are of detailed questions about illness in first and second degree relatives, being examined fully clothed (it was winter and there was no heating), and being led into a room with other women undergoing the examination for a far from private pelvic examination. Then there was the peeing into a little plastic cup in the very insalubrious public toilet on the street outside before walking back into the hospital amid the crush of outpatients, trying to avoid any spillage. Two days later the certificate of health for marriage was duly awarded.

My understanding is that these checkups are voluntary nowadays.

  • Thank you, this is a solid investigation. I appreciate that you broke down the situation into legal gender identity and legal marriage requirements.
    – alexw
    Commented Jul 8, 2022 at 15:46

This is a misunderstanding of the claim.

This is not about premarital exams but rather about gender identity. East German law required that a marriage was between a woman and a man (something that was very common internationally back then). GDR family law, §5 starts with "Mit der Eheschließung begründen Mann und Frau ..." in English, "With the marriage of a man and a women ..".

The gender of a person was defined as whatever was written in their national id. Hedwig was born as a man and her East German id said 'male' (this is a work of fiction, this information is from the Wikipedia plot summary). The only way for her to get married to a man was to get gender reassigment surgery and then change her official id to female.

  • 2
    "very common" is an understatement; it was universal.
    – gerrit
    Commented Jun 27, 2022 at 10:12
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    "East German law required that a marriage was between a woman and a man" — OK, but did they perform physical exams to enforce that? Your answer doesn't say.
    – jwodder
    Commented Jun 27, 2022 at 12:15
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    @quarague That still doesn't get to the heart of the matter, though: would there have been a physical exam in order to get a new ID? Would acquiring that new ID even be possible?
    – IMSoP
    Commented Jun 27, 2022 at 13:39
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    @IMSoP That is indeed not answered but to me that looks like a new question: Could you get a gender change in the GDR and what was the procedure? I don't know the answer to it but to me that goes way beyond what OP asked.
    – quarague
    Commented Jun 28, 2022 at 6:09
  • 1
    @quarague I think we have different interpretations of the intent of the question, rather than its exact wording - to me, the "physical examination" part is more important than the "premarital" part. The question asks "is there a historical basis"; requiring an examination to get a new ID would be a historical basis.
    – IMSoP
    Commented Jun 28, 2022 at 6:35

I understand from the comments that this question isn't limited to "Did East Germany do physical examinations to determine the sex of engaged people?" but "Did any jurisdiction require pre-marital medical examinations?"

The latter is much easier to answer.

Yes, New York State currently requires a medical test to be conducted to detect sickle cell anemia for some races. (Sickle Cell Anemia is an inherited disease, which is more prevalent amongst the black and hispanic communities.)

1. On and after the effective date of this act,  such test as may be necessary shall be given to each applicant for a marriage license who is not of the Caucasian, Indian or Oriental race for the purposes of discovering the existence of sickle cell anemia and notifying the applicant of the results of such test.

2. No application for a marriage license shall be denied solely on the ground that such test proves positive, nor shall the absence of such test invalidate a marriage.

3. The provisions of this section shall not apply to any person who refuses to take such test because of his religious beliefs.

There has been a long history in the USA of pre-marriage medical tests being required. Mental Floss explains this was an effort in the 1930s-1940s to reduce the spread of syphilis, and then later tuberculosis, rubella, and HIV.

The laws were repealed because they were not effective screening programs.

  • Thank you, this is a good and relevant answer but I chose the other answer because it gets closer to the legal implications of GRS.
    – alexw
    Commented Jul 8, 2022 at 15:58

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